For aging Americans and the healthcare professionals that serve them, aging in place at home is more important than ever in keeping healthcare costs down and health outcomes high. Two home-care options for Medicare Advantage plans and health systems include non-medical home care and medical home healthcare.  Let’s dig into defining the fuller meaning of these terms, review how they are different from one another and how they can work together in partnership to meet the needs of the elderly.

What are medical home healthcare services?

Home healthcare services or “skilled care” covers activities normally administered by a registered nurse, occupational therapist or other licensed professional, performed in a senior’s home. Medicare Advantage health insurers have long included medical home healthcare in their benefits packages and consider the following services “home healthcare.”

• Intravenous therapy, such as nutrition therapy and administering antibiotics
• Occupational therapy, which can include assistance with activities of daily living such as balance, dressing and ambulation
• Pain management
• Physical therapy
• Speech therapy
• Wound care

What are non-medical home care services?

What does a home care aide do that a home healthcare professional does not? A home care aide or caregiver requires no professional license and typically assists seniors with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and key social determinants of health (SDoH). Most long-term care is home care to help people live as independently and safely at home for as long as possible. Home care aides may serve as in-home caregivers or live out of home. Either way, they must possess compassion and common sense and have passed a background screening. Home care is sometimes also referred to as custodial care, companion care, homemaker services, non-clinical care, personal care, and unskilled care. Some of the services typically performed by a home care aide in a senior’s home include:

• Transportation
• House cleaning services
• Medication reminders
• Shopping and meal preparation services
• Caring companionship
• Help with paying bills
• Help with personal services including dressing, bathing, toileting or grooming

Health outcomes of in-home services

Whether a senior patient has long-term chronic conditions or is recovering post-surgery, they manage health problems better when they have in-home support. Research shows that in-home care – medical and non-medical – lets patients stay safely at home, provides better case management, and can greatly reduce re-hospitalizations and premature nursing home admittance.  Research conducted by Humana in 2015 shows that patients who used their non-medical At Home care services lived longer and went to the hospital less often than people who didn’t. The Humana At Home services used by these patients included companionship, medication supervision and many activities of daily living such as help with dressing, shopping, preparing meals and managing money. It also shows that 338,000 people who used Humana At Home services were well enough that they had 718,000 days at home instead of in the hospital.

Cost savings with home care

Home care makes recuperation more efficient because it decreases the need for more expensive interventions. Home care reduces costs, one reason why some healthcare professionals call it “the safety net of health care.”  According to a recent study published in the Annals of Internal Medicine, Medicare loses $4 billion due to costs of incidents arising from the lack of in-home care services. These costs are especially high for patients with disabilities, the study found. Medicare recipients with disabilities account for about 15 million people. CMS has broadened home-care benefits in the past few years. CMS officials believe that approving more home health and in-home services for older adults and those with disabilities improves medical care outcomes and lowers costs.

Who pays for medical home healthcare and non-medical home care services?

Medical home healthcare

Medicare Part A or Part B cover some home healthcare services, but conditions typically must be met. A few of these conditions include a doctor’s prescription or authorization for a short-term medical need; the member is confined to home; the member is actively recovering (as opposed to is stabilized); and the care must be provided by a Medicare-certified home health care agency. Medicare recipients qualify for Medicare home healthcare under Federal rules while each state determines the requirements for Medicaid in-home care services, which differ from state to state.  Medicare Advantage plans, or Medicare Part C, must provide home care if the member meets the conditions outlined in Part A or B above. They may also provide some additional home healthcare benefits with or without those conditions, often as a vital bridge to post-acute patients returning home after a hospitalization.  

Non-medical home care

With non-medical home care, Medicare will sometimes pay for short-term care (100 days or less), contingent on it being paired with in-home clinical care that’s prescribed by a doctor.  Medicare Advantage plans began to cover various in-home care services starting in 2019, though only three percent of MA plans offered them that banner year. The number of plans offering in-home care services should increase substantially over the next few years as health insurance companies jockey to stay competitive: home-care benefits are among the most-desired benefits for seniors, and health insurance plans are anticipated to start offering them in earnest in 2021.  For seniors who want home care options that aren’t covered by Medicare or Medicare Advantage, they must pay out of pocket.

Home care and home healthcare working together

Services that clinical home-healthcare workers and non-clinical home-care workers provide are not mutually exclusive – they’re complementary. For example, a post-surgical patient released to his or her home may require wound care but would also benefit from ADL assistance with bathing, meals and housekeeping.  The cooperative nature of the care can greatly improve a patient’s quality of life and reduce the risk of hospital readmissions and premature nursing home admittance. The care and compassion exhibited by both sets of professionals can not only provide a better clinical outcome, but also greatly increase the policyholder’s satisfaction with their health insurer.